Surrender Request

This field is hidden when viewing the form

Date(Required)

Owner's Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Dog's Name(Required)

First

Breed(Required)

Sex(Required)

Age of Dog(Required)

Microchip Number

Is your dog spayed or neutered?

Is your dog UTD on vaccines?

How long have you had this dog?(Required)

Was this dog adopted?(Required)

Who did you adopt the dog from?(Required)

Why are you surrendering your dog?(Required)

Please be as specific as possible. Examples include job change, move, behavior issues (specify), lack of time, inability to contain, doesn't get along with dogs, needs training (be specific).

Do you want to keep your dog while we look for a home?(Required)

How quickly do you need your dog out of your home?(Required)

Has your dog ever bitten a human?(Required)

If yes, please provide details:(Required)

Has you dog ever bitten another dog?(Required)

If yes, please provide details:(Required)

Please mark all that apply:(Required)

My dog:

What are some tools you've used to train your dog?(Required)

Has your dog ever killed or seriously injured another animal?(Required)

If yes, please provide details:(Required)

Has your dog ever had significant health issues or injuries? If yes, please provide details:(Required)

To the best of your knowledge, has your dog been exposed to a wild animal (dead or alive) in the last 30 days?(Required)

Please provide any additional information you'd like to give us.

Please upload a pic(s) of your dog that clearly shows its face.(Required)

Drop files here or

Max. file size: 50 MB, Max. files: 3.

Please upload vet records.

Drop files here or

Max. file size: 50 MB, Max. files: 3.

By signing my name below, I certify that I am the legal owner of the above described canine. I surrender all claim of ownership to the above described dog to Mile High Canine Rescue without recourse. I will make no effort to reclaim the above described canine. I have supplied truthful information to the best of my knowledge.

I understand that I have chosen to act as a foster for my dog while it is being placed for adoption. I am doing so at my own risk. I agree to reimburse Mile High Canine Rescue, Inc. for any costs incurred by them for my dogs vetting or care if for any reason the dog is not adopted out by Mile High Canine Rescue. Further, I forever release Mile High Canine Rescue and its' directors, officers, volunteers, and assigns from any and all liability and/or claims (whether personal property, injury, or medical) associated with my dog.

I understand this Surrender Form must be accepted by Mile High Canine Rescue, Inc. before it becomes legally binding.

Name(Required)

First Last

Date of Birth(Required)

Signature(Required)

This form is a surrender of ownership. Please answer questions candidly and honestly. This form becomes legally binding once accepted by MHCR.

Many times issues with a dog can be resolved with professional assistance. Click the button below for resources and recommendations.